Invited Commentary
Practice Gaps
September 2013

Frequent Debridement for Healing of Chronic Wounds

Author Affiliations
  • 1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Dermatol. 2013;149(9):1059. doi:10.1001/jamadermatol.2013.4959

Chronic wounds, such as from diabetes and vascular disease, affect almost 7 million Americans annually, cost nearly $25 billion annually, and are associated with increased mortality.1 Standard care for the treatment of chronic wounds includes debridement, with best evidence existing for diabetic foot ulcers, where secondary analysis of randomized trials suggests centers with higher frequency of debridement have superior healing rates.2 The rationale for debridement is to remove tissue and debris that inhibit healing, which at times is obvious, for example, when necrotic eschar or excessive callus is present, but at other times is less obvious, for example, when trying to remove bacterial biofilms or abnormal host cells that may also contribute to slow healing. For example, keratinocytes adjacent to chronic wounds have a diminished ability to migrate and respond to growth factors and contribute to a pathogenic phenotype that inhibits healing.2

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